One physician’s burnout and unconventional rise from the ashes

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After taking a thoughtful break from posting (aka being busy and not writing), I find myself today with an unexpected afternoon off, and thought it would be a great time to reconnect with my blog. Let me start with apologies to a few of you who took the time to get in touch me with me – to say I was “delayed” in getting back to you would be the understatement of the year. #epicfail. Hopefully I’ve caught up with everyone at this point.

I find it interesting that I chose to blog today on balance, because I have quite a few “real” tasks staring at me from by inbox with rapidly approaching deadlines. But I think this illustrates the point of balance precisely, at least in my own experience. Sometimes achieving balance is committing to things that bring you joy and pleasure outside your job as intently as you commit to work, and knowing when you have the leeway to do so.

In my previous career position as an academic physician, I burned out rather dramatically after only 6 years in an attending-level position. I’ve now hit the 4 year mark at my current job, and continue to look forward to going into work, taking on new challenges, and investing effort into expanding my program (including training a new advanced practice provider who is SPECTACULAR to work exclusively with me – props to my department chair for hiring her without batting an eyelash when I asked if it was possible). One of the critical characteristics that I think separates these two experiences is balance. More specifically, self-defined balance.

In my previous job, I spent a lot of time doing either what other people told me I should be doing, or doing things because I thought I should be doing them out of guilt, obligation, resume building, etc. Don’t get me wrong – as a newly-minted attending fresh out of residency, a huge part of my job was to say “YES!!’ to work that came my way.

I’m quite convinced that one of the big contributing factors to me burning out was my lack of balance over time. And when I really look at how that played out, it was really subtle and quite tricky. Make no mistake, I am BUSY AS F**K in my current job, and I say yes to plenty of things that come my way. But how I spend my time is much better tailored to my own preferences.

The nice thing about trying to pick this apart is that at my old job, I was 60% FTE, and that’s exactly what I maintain at my current job (despite intermittent check ins from my chair to see if I maybe want to bump up my time a little…. thank you, but the answer is still no.) But my balance now is so much more appropriate for me, and the changes may appear small, but have huge consequences.

Where I used to work (which I will henceforth refer to as “Mordor”), I did all sorts of work outside my contracted hours, which seems to be pretty much true for most physicians in the US. I took overnight call for the clinic a couple of times a month (meh), covered the nursery one week every few months (gross due to the early hours), and took a Friday through Monday call weekend once every eight weeks, which was a F**KING SLEEPLESS HORROR SHOW that was exacerbated by the fact that we had absolutely zero nursing triage, because god forbid that would have COST MONEY. This functionally translated into EVERY SINGLE CALL from a parent coming through directly to the on-call pager, including the father who called me at 3 am to let me know that HE HAD RUN OUT OF BABY FORMULA.

Needless to say, this was not a great sustainable model for happy employees.

At my current place of employment (which I affectionately refer to as CandyLand), I am also asked to engage in activities that are outside my contracted hours. These include things like developing a lecture series for the department on use of culturally-inclusive language (winning), create a core curriculum in my area of expertise for our residents (also winning), and chairing a community resource multidisciplinary committee dedicated to improving developmental outcomes in early childhood (winningest win!). I invest quite bit of time and energy into activities like this, but I never feel taken advantage of being asked to do them, mainly because they are things I naturally enjoy. If you look closely, you will also notice that none of these activities involve taking overnight call, which for me is a personal Dante’s inferno. Some people really are not too phased by being on call, but I have discovered that I would pretty much rather suck on hot lead than take call. I even made a personal investment in not taking call by purposefully leaving money on the table when I initially negotiated my contract, stipulating that I wouldn’t be taking call. And my department was fine with it. #balance

When I was working in Mordor as a 60% employee, I had most mornings to myself. Which sounds awesome on paper. But because the 60% (plus all the extra bullshit overnight call that turned me into a walking zombie) was so draining and I was so unsupported in my role, I didn’t have a lot left to put into the other 40% of my week. Even things I liked were a chore, because I didn’t have much energy for them. Working out was a necessary evil (and I’m a person who LOVES to work out). Learning a valuable skill, like cooking, was out of the question, and my husband’s and my diet suffered for it. By the time I left, I was on medicine for reflux and high cholesterol, and was a borderline diabetic.

Now working in CandyLand, my 60/40 split looks much different. As fiercely committed to my career, my department, and my patients as I am, I am equally as committed to my own health. My time away from work, for the most part, remains my time. Through a series of random events, Crossfit found its way into my life (don’t get me started – that’s an entirely separate blog post). Now four mornings a week Monday through Friday, rain or shine, I am at the Crossfit box, and absolutely adore it. And I treat it pretty much as a scheduled standing meeting between me and my health. I don’t use it as “swing space” to hold extra clinics, meetings, projects, etc. I also learned how to cook, and make a healthy home-cooked dinner at least four times a week. My reflux is gone, my glucose is under control, and I have the cholesterol profile of a 16 year old. #balance

The bottom line is that it took me years to recognize how much the part of my life I’m at work affects the rest of the time I am not, and that I am pretty much the only person who has real power to do anything about it. It’s kind of like having a really good bed – the 30% of your life you spend in it plays heavily into the 70% of your life that you aren’t.

So….it’s been almost TWO YEARS since I last posted. (No, I don’t count the intro blurb I wrote to Fiona Scott’s kind guest post more recently.) Part of me feels pretty bad about that. I enjoy writing immensely, but I have enjoyed even more hearing from readers who have chosen to share their own experiences, and being constantly reminded that as alone as physicians burnout feels, we are in (shockingly) good company.

But at the same time, there is a part of me that is admittedly quite pleased I haven’t posted, for the simple reason that I have been BUSY. And not busy-work busy, or toxic miserable crazy busy. I have been busy with really, really good and satisfying work that I am extremely passionate about. So at least I have a somewhat decent excuse for my lapse in blogging.

Lately, I have found myself perusing other blogs that focus on physician burnout. I’m not completely sure why, but I know that I have a definite sense of having escaped something, and I feel like in some way I need to remind myself of how bad things were, so that I don’t let the edges get fuzzy with the passage of time and become complacent about how good I have it now. One thing is for certain though: I am absolutely, positively convinced that my current happiness and job satisfaction have a tremendous amount to do with the fact that I work part time.

Now let’s be totally clear about one thing: the physical rules of the time-space continuum simply do not apply to those practicing in the medical field. I suspect there are other career paths that also suffer from this wormhole phenomena, but medical practice is the one I am intimately familiar with. It is very important to make the critical distinction between a part time contract, and part time work. Take my contract for example. On paper, I am contracted and paid for 60% of an FTE (Full Time Employment) position, which constitutes 5 clinical sessions a week plus one half day for “administration”. This amounts to 24 contract hours a week. In actuality, I work much, much more than that.

For one, my admin time (as I suspect is the case for most other practicing physicians) is a nice euphemism for “anything that is not direct clinical patient care”. This includes reviewing charts for my upcoming consultations for the week, teaching medical students and residents, chairing committees, writing and publishing articles, completing charts on my finished patient visits, answering barrages of emails, training, etc etc etc. Does that fit nicely into a 4 hour block every week? F**k no it absolutely does not. Then add on when patient care becomes more complex than predicted, and you have a setup for potential disaster.

Except that, until recently, I have never had an issue with the spillover for two reasons. One, I have built in buffer in that I don’t work 40 hours a week, so if I have a particularly demanding week, I have some wiggle room. Two, I simply ADORE what I do, and the people I work with. So when a week is hard, or long, or maybe even just sad, I can still step back and not lose sight of what an absolute privilege it is to hold the position that I do.

This was how things were chugging along anyway, until a few months ago.

I managed to catch whatever hellish upper respiratory infection was floating around, and I got sick. Like SSSSIIIIIIIIIICCCCCCCKKKKK. Like febrile and coughing so hard I thought my uterus was going to fall out on the floor. The kind of sick where I actually had to CANCEL THREE DAYS OF WORK.

Unfortunately, this also went down the week before I had already scheduled a makeup clinic for when I had been out of town at a conference. I didn’t really pay attention to this small fact when I rescheduled all my missed clinics from being out sick for the following week when I got back.

What this ended up translating to was a regular work week, with four full makeup clinics scheduled on top of it. Essentially, I had scheduled the equivalent of shoving 20 pounds of crap into a 10 pound bag.

And as you can imagine, it absolutely SUCKED.

My admin day was doubled since I had to chart review twice what I normally do in a week. I ended up staying until about 8 or 8:30 each night finishing my charts since I had seen twice my normal patient volume. For the first time in three years, I found myself at the end of the day feeling utterly sapped and not at all looking forward to coming back to work.

But the effects went beyond work. Absolutely nothing got done that week. NOTHING. No laundry, no food shopping, no workouts, zero. My husband and I ate out five nights in a row because there was simply no time or energy for anything else, and by the end of the week that wasn’t enjoyable either.

I don’t mean to be melodramatic. I totally survived the week. But that’s pretty much because it was one week, and I knew it wouldn’t last.

Most importantly, that week was looking an awful lot like the first job that I eventually walked away from. It was a great reminder of how I did not want my career, or my life, to look anymore.

My contract may say part time, but my work life is quite full. Physicians by the very nature of their mission are vulnerable to the threat of becoming “overfull”. And when we are unable to take care of ourselves, it becomes virtually impossible to take care of others.

So recently I was approached by a medical student asking if she could guest post on my blog about burnout. I was more than happy to take her up on her offer, and not just because it has been WAY too long since I have blogged and her timing could not have been more perfect. It’s easy to forget that physicians in training are not in any way immune from burnout and compassion fatigue that affects so many of us out in clinical practice. Fiona shared with me that she had recently lost a classmate to suicide – something I unfortunately also experienced during my training when one of my fellow medical students killed himself during our first year. If anything, the pressures and difficulties have only seemed to have grown during the time between my and Fiona’s training.

I welcome Fiona’s piece on her experiences so far during medical school – while I remember it like it was yesterday, I am far too removed to comment on the current climate in medical education. Although apparently…some things don’t change.

As always, thanks for reading.

~Lumi

Help Wanted…Inquire Within

by

Fiona Scott

I did some pretty crazy things to get into medical school (don’t worry mom, nothing illegal). For several years before applying I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school…and graduate… and I waited, I hoped. I did research (which involved a little too much rat killing for my liking), I worked in a peach orchard to demonstrate my dedication to migrant farm worker health. I became an EMT, I got three master’s degrees. I got as close to medicine as I could. And I wanted it. I wanted it bad.

So when I was finally accepted to medical school at the ripe old age of 27, I was giddy with excitement at my dream finally coming true. So excited in fact that I ate an entire chocolate cake and finished the better part of a magnum of champagne (the hiccups that ensued were horrendous).

When I walked into my very first medical school class, I thought my excitement would allow me to float through the next four years with ease. I was getting my dream, and damn it, it was going to be amazing. And in many ways, medical school has been really amazing. My classmates are wonderful, kind people most of whom I hope to remain life long friends with. The course work in med school was challenging, but paled in comparison to graduate school. I excelled in my classes and it felt awesome.

But then things started to change. I began to see some of the realities of practicing medicine that I was blind to before. My previous ideas about the kind of power doctors had to affect change were shaken by anti- vaccers and insurance companies. Even my very own University shattered my naivety by refusing to care to a patient with cancer seen in one of its well-publicized free clinics. By the end of my first year of medical school, my heart was so heavy with broken pieces of what once was my perfect idea of medicine, I felt like ripping it out of my chest and drop kicking it across the floor. What the hell kind of profession did I just sign up for?

I started to question whether medical school—and more importantly becoming a doctor was really what I wanted after all. And that scared the crap out of me. Did I make a mistake? Why had I never doubted this is what I wanted to do before? Will I be $300,000 dollars in debt before I realize I should have been a real estate agent?

At the end of my first year of medical school I was desperately trying to figure out how to reconcile the immense challenges and problems of medical care with the amazingly wonderful parts. With over 400 physicians committing suicide each year1—the highest suicide rate of any professional group– I was starting to think that medicine had more misery than anything else. Maybe med school applications should come with a warning label.

For now at least, I am well protected from most of the soul destroying realities of the medical profession, ironically by the school training me to enter it. Medical school is for all intents and purposes is a safe haven to which I can retreat deep into my books, where my patients are just actors (paid professionals working as ‘standardized patients’ to help train us for the real thing) and where the excitement of wearing scrubs and carrying a pager never seems to get old. When things get “too real” I cling to the fact that I am just a student, still in school—not yet a doctor charged with caring for real patients within a broken and frustrating system.

But it scared me when I think about what my career in medicine will look like. I imagine my mentors and professors– kind, loving people who believe that I am worth teaching and humbly guide me- even though its more time and hassle to do so. These are the ones I strive to be like– the ones who show up to help, even though they feel frustrated sometimes, even though they can’t always fix the problems in front of them. These are the heroes I look to to remind myself why I signed up for this. I don’t want to watch any of them turn into burned out shells of their former selves. And I fear more and more that this is happening. And I worry most of all that it is happening to me

But I’m too young, you say. Too early on in my training to have any legitimate claim to feeling burned out and disillusioned with medicine. If only that were true. A study of all medical students in the United States found that about 49.6% of medical students met the criteria for burn out2 and 51.3% for depression3. Trust me—its not all from studying, but from being treated like crap, feeling like we can never make a mistake or ask for help and wondering if anything we do will help to change the status quo or are we just cogs in a wheel trying to crush us.

One of my favorite authors, Anne Lamott, says, “Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don’t give up.” So here I stand. In the dark, unsure about where the future might lead, but clinging to the belief that medicine will give me joy, and satisfaction and hope—in spite of the drawbacks and hardships.

As I grow into my medical career, others who have gone before me will light the way ahead with “I’ve been there,” “It will be okay” and with “screw this, let’s grab a beer.” There is immense power in showing love and support to others in our profession. Sometimes it’s the most powerful thing we can do and sometimes it’s the only thing we can do. And I know. Because the regular author of this blog reached across the time space continuum of the internet to provide me—a perfect stranger– with the strength to continue on in my medical training. It was her graciousness and honesty that reminded me why I was so taken with medicine from the start. Our voices have the power to change lives and, most importantly, to change our own.

It’ s been over a year since my last post. Apparently, I am one of the worst bloggers ever.

But you have to admit, it’s a little challenging to have had an active blog about leaving clinical medicine, and then go back to clinical medicine. It leaves you with not so much to say. I’ve actually considered stopping the blog altogether, since the entire reason for me starting it has pretty much vanished.

Except that I’ve realized that a) I really like writing, and b) maybe the blog just needs a slightly different focus. Perhaps a focus on the path out of medicine just needs to be a little broader and include the road back.

So here it is. I am dusting off some serious cobwebs.

It’s been a year and a half since I came back to medicine. At first it was very tentative. I started back at one day a week just to give it a shot, fully expecting that it would be the same misery as before and I would be out within 6 months. Which is course is not at all what happened. I’m now at 60% time (with my chairman constantly begging me to do more) and having to train another provider to help handle my patient volume. And I actually chose to do this.

I recently finished the longest week of work I have had since coming back to clinical medicine. I had a family emergency and a conference all converge around the same week, and ended up rescheduling two days of missed work into an already full week. It was long. It was incredibly tiring. I was very glad when I finally got into my car on Friday evening to drive home.

And yet, it wasn’t a bad week. It actually wasn’t even an ok week.

It was a really, really good week. Yes, I was exhausted and completely ready for dinner out with a self-medicating glass of wine. But I was just tired from working hard at an unbelievably rewarding job.

I’ve had a ton of time to think about what makes my current situation so ridiculously different from my old job. I’ve blogged about the concrete differences that make my new life so very different from my old. It’s very multifactorial, and certainly not simple.

Except that now, having gotten plenty of time and distance from my old job (and really, my old life), it actually is kind of simple.

When I look at all the different factors that are involved in loving my current work, they all have one thing in common. From a truly exceptional chairman and an outstanding support system and dedicated nurse, to things as simple as having a nice office with plenty of windows and reserved doctor parking in the garage, all these reasons essentially boil down to one simple factor. At first I thought it was people liking me, but I realized that plenty of people liked me at my old job, and I was a miserable wreck. I thought it might be that now I am respected, but no, I had plenty of respect where I was too.

Then I realized – it’s the “V” word.

The reason that everything continues to be unicorns farting rainbows where I work a year and half after starting is that, after all this time, I am finally VALUED.

And lest I sound the least bit bitter about not being valued at my previous job, I fully realize how difficult this can be to achieve.

I think it’s extremely easy to confuse being valued with other ideals, such as being liked or respected. They certainly share certain attributes, and we all feel good when we experience any of them. I recently drank the Koolaid and read Sheryl Sandberg’s Lean In. For those of you who have only just joined the human race, Sheryl recently became the COO of a teeny tiny social media company called Facebook. She wrote a very poignant (and controversial) book about women breaking into and taking on high powered positions in major companies.

Did I agree with her 100%? Of course not. And there were definitely parts of the book I didn’t relate to, such as having children and balancing all that out. Which is clearly an entirely different blog for an entirely different person other than me to write.

But Sheryl’s book was amazing. Some of those pages felt like she was writing them specifically for me and me alone. I won’t go into excruciating detail if you haven’t read it….ok screw it, I’m totally going to talk about what I thought was the best part of the book. Sheryl has a chapter on career paths, in which she discusses a phenomenon called “The Tiara Syndrome”. Yes, it does do some gender stereotyping, which Sheryl is very graceful about addressing in her book. Basically, women in general tend to function similarly when it comes to their view on success at work. We roll up our sleeves, put our heads down, and do really, really good work. And we keep doing good work. And we do some more good work. We don’t promote ourselves, we don’t draw attention to all the great things we are doing, we just work. Because if the work is good enough, and we do enough of it, someone will eventually notice what an amazing, wonderful job we are doing, and come over and plop a tiara on our heads to thank us for all of our efforts.

TAAAAAA DAAAAAA!!!!!!

I was absolutely, positively, 100% a tiara syndrome devotee. And let’s be honest, half of getting through a clinical medicine residency is picking up your pom poms and cheerleading your way through all the fatigue and the stress and the trauma. We train for YEARS to roll up our sleeves and put our heads down and work. And when one of our attendings tells us we did a good job, it’s like winning the lottery.

The problem is that the model for getting through residency is nothing close to the model for having a fulfilling and successful career for the rest of your life.

In my old job, I was a total tiara girl. I started a specialty clinic during my residency and grew it from one family to 5 families to 15 (headdownworkworkwork). And I stayed on as faculty after I graduated and continue to serve as clinic attending, and taught residents, and published in peer reviewed journals (headdownworkworkwork), and organized conferences, and grew my clinic to 50 families to 100 to 200 (headdownworkworkwork), at which point with virtually NO help and NO support staff and NO meaningful salary, I completely imploded.

Was I liked? Absolutely. People LOVED me. Was my work respected? Definitely. The residents gave me teaching awards, students would come back for a second elective rotation with me to learn more, colleagues would proudly laud my achievements to other colleagues.

Was I VALUED? No. No sir, I most certainly was not.

Because here’s the thing about being valued. (And, in general, women tend to do this more than men.) It’s super easy to confuse being valued with being liked. We get the warm fuzzies with both being liked and valued. They can look deceptively similar at first glance.

Here’s the catch. To put it bluntly, you can be extremely well liked by your colleagues, and still have promises made to you that are going to be broken, be assigned a terrible salary that doesn’t even come close to acknowledging COLI let alone acknowledge the work you do, made to feel like no matter what you do it’s never enough, and be put in a situation with no help and no real way to succeed. You can be the belle of the ball socially and work can suck suck suck.

As much as we don’t want to admit it, the reality is that it is simply not enough to pat me on the head and tell me I’m doing an exceptional job, and throw me peanuts to survive on. And for some reason, historically women (in general) have tolerated this much more so than men.

I don’t mean to digress into a gender inequality in the workplace blog (there are plenty of those out there already, and did I mention Sheryl Sandberg’s book?) This is about recognizing what you need as an individual to succeed. Personally, it took me quite some time to figure it out. I need to be truly, honestly, and tangibly valued.

Let me be clear – this is not at all solely about a paycheck. Ironically, because I’m a generalist who has specialized and am now working in a surgical department, I am BY FAR the lowest paid faculty in the department. I don’t cut into people for a living (God bless those of you who do and do it well), and my paycheck shouldn’t reflect that I do. But I will tell you one thing: as an academic clinical assistant professor, I am making a very, very nice salary. And my chairman is thrilled to give it to me. It’s like every month, there’s a little subliminal message from my department in my bank account saying “Hey Lumi, you are totally worth it! Thanks!”

But the salary is the tip of the iceberg. Ironically it’s the small things that really add up in terms of feeling valued. When I pass my chairman in the hall and he is talking to someone I haven’t met, it is 100% guaranteed that he will stop me and say, “Oh Dr. St. Claire, have you had the pleasure of meeting so-and-so-chairman-from-blah-blah-department yet?” And then will go on to completely talk up my work ad nauseam to this poor trapped soul about how special my clinic is and all the innovative things we are doing, etc. His elevator speech has actually gotten quite good.

Or when my colleagues refer a child to me that they just don’t know what to do with, and tell me how relieved they are that I am here and can help out with complex care coordination that they just aren’t equipped to handle as surgeons.

Or when the medical assistant screening my patient leaves me a little note on the computer in the room that says “Hi Dr. St. Claire – have a super day!”

Or when my colleagues from the community ask me to chair a committee to try to bring resources together to best serve our patients and families. And then when we have the meeting at 3pm on a Monday, my clinic coordinator naturally assumes I will want it catered, because how on earth am I supposed to host a successful committee meeting without feeding the participants?

Or when our admin sees that I am still in my office on Friday at 5:30pm charting, and runs down to the first floor to bring me a Diet Coke so I can keep working (which may be the reason why I woke up so early this morning thinking about this stuff – caffeine and I are not exactly friends).

I could go on and on with these little encounters that individually could be seen as trivial. But when every single day at work is FULL of these kind of interactions, you start to feel rather glowy and lovely all the time. Do I have hard days? Of course. Do I occasionally have challenging families or situations that make me sad that I can’t do more? Absolutely. But working in an environment where I am not only liked and respected, but valued, makes me finally, finally understand what Confucious was talking about when he said,

“Choose a job you love, and you will never have to work a day in your life.”

My new cyber-friend, Dr. Ryan Gray, invited me to submit a guest post to his blog and podcast site: www.medicalschoolhq.net. It’s a great resource for premed students who are trying to navigate the pathway to medical school. Ryan asked me to write a guest post on burnout geared toward premed and med students. You can find it here. Thanks for checking it out!

Happy New Year! Nothing says a fresh start to 2013 like a closeup photo from The Shining. 🙂

But I am back. Part of me wants to hedge and say “well, I am back….but sort of”, or “well I’m just part-time.” Until I quickly realize that those are old, familiar, ridiculous cultural scripts that I have been purging from my life for the past three years. That crappy mantra that you spend a good chunk of your life training for a profession that you truly have no idea what will look like over the course of your life, and then you get a job and stay in it for the remainder of your career come hell or high water.

What a crock.

For those of you who regularly read my blog (and a very special Happy New Year to all 33 of you!), you know that roughly three years ago I essentially walked away from more than a decade in clinical medicine to reclaim control over my life and happiness as a consultant. It’s been a wonderful and powerful growth experience, and a great exercise in trimming the b.s. out of my life.

So I was understandably surprised at myself when I decided last year to get back into clinical practice. (For the gory details, feel free to visit my post “Dipping a Toe Back in the Pool“). I’ve now been back in academic clinical medicine for roughly 3 months, and a few of you have asked me for an update on how things have been going. So here it is:

Keeping in mind that I am still in my honeymoon phase and I have yet to experience all of the crazy politics and administrative pressure of being back in clinical practice……I am over the moon, deliriously, spectacularly happy.

I don’t think this is an accident. I think this is an amazing combination of right people, place, and time. Specifically speaking:

1. My chairman is a god. Ok, well that’s exaggerating. Mostly he’s a simply fabulous guy who has managed to become a very skilled administrator while maintaining his coolness as a human being. He hired me for a very specific role, and since my arrival has not for one minute started piling on “other duties as assigned”. In fact, there is no such clause in my contract (this being my second time around at this particular rodeo). In fact, the person who is putting the most pressure on me to be productive is me. As far as he’s concerned, my first year of salary was a line item in his budget, and he is constantly reminding me not to put too much pressure on myself in my “ramp-up” period. He also tends to hire lovely, energetic, passionate physicians, so I am surrounded by a department full of (mostly) amazing and happy colleagues. Yes, I think he is part alien. He also had a charming accent and likes to put “eh?” on the ends of his sentences, even when they aren’t questions. Lovely.

2. I am protected from the aspects of clinical medicine I found most damaging in my previous existence. Really this boils down to three things. First, I don’t take any overnight call. NONE whatsoever. Some docs don’t really mind overnight call. For me, it made me beyond miserable. To be fair, my last incarnation of overnight call was in the most dysfunctional model you could ever imagine: in an outpatient practice that received 35,000 patient visits a year, we had NO nurse triage to screen overnight calls. ANY parent that called into the clinic was routed directly to the on-call physician. Which meant we were answering parents calling us at 2 in the morning to let us know that their child has had a mild cough for the PAST THREE WEEKS and what should they do about it right that instant? My favorite was a parent who called me at 4 am to tell me they had run out of baby formula. Clearly, I went to medical school so I could direct people to look up their local all-night drugstore.

Second, since I don’t have any call, I HAVE NO PAGER. For those of you who have never carried a pager so long it has actually melded with the flesh near your right hip, you won’t totally get how important this is. I nearly broke out into a little dance in my chairman’s office my first day at work when he looked at me in his thoughtful way and said, “No, I don’t think you need a pager….not at all, eh?” My colleagues and my administrative staff all know how to get hold of me through email or my cell if it’s urgent (which it rarely is). Getting rid of that piercing electronic tumor at my waist has been a very liberating experience.

Third, I have SUPPORT. A LOT of it. I have an administrative assistant who handles all the scheduling and paperwork nightmare that I used to have to do for myself. I have a coordinator who schedules all my patients, takes care of all the insurance approval, and vets me through the right offices for any need I have. I have a dedicated nurse in clinic who knows exactly how I like to see patients. And most importantly, all of them are HAPPY to do their jobs. It’s a miracle.

3. I am part time. I cannot stress enough how this has been the cornerstone of my happy return to clinical care. I spent the last three years developing a thriving and satisfying consulting practice, and there was no way I was going to walk away from that. I’ve started back clinically working one day a week. Realistically, I work a little more than that in that sometimes I have to take care of some occasional communication or patient followup a different day of the week. Which, when you love your job, is not a resentful situation at all – it’s part of building a practice. But it allows me to grow at a unhurried pace and not have any anxiety about justifying my salary. Plus we have already planned for adding in a second day if (when?) my practice gets too big for one day a week. Mostly though, being part time protects me from the institutional and administrative politics that I found so damaging in the past. Working once a week, there is no expectation that I will sit on multiple committees, attend numerous staff meetings, or get sucked into university service I have no interest in doing. The things I get involved in I do by choice, and make sure they are projects I want to be part of.

4. I am valued. In this disposable day and age, it is simply miraculous to work in a place where you get to provide a unique service that no one else does, and people actually tell you how grateful they are that you are there. The fact that I view this as miraculous is sad, but it’s just a fact.

I know how fortunate I am to wake up pretty much every day of my work week now and look forward to what the day has in store for me. I also know it’s not luck – a lot of work went into making this happen, and still does.

In the spirit of moving forward in a new year, I’m including a link to Kathy Caprino’s most recent article, “The 8 Most Damaging Excuses People Make for Their Unhappiness.” I have always found her insights to be spot-on when it comes to getting unstuck and allowing yourself the opportunity to have a happy and healthy career.

For some reason, I spent the entire bulk of today fending off the phenomenon I refer to as “mi loca, tu loca”. Which translates roughly to “my crazy, your crazy (and that plus asking for the check at dinner is just about the extent of my Spanish.)

The MLTL experience is one of the things in life that truly, deeply gets under my skin. We all have experienced this at least once. If you haven’t, you either live under a rock or have a life that is so pleasant that June Cleaver would shank you out of pure jealousy. MLTL happens when someone else tries to make their crazy your crazy. And I am not talking about garden variety attempts to convince you to see their side of the story. No, this is actually infecting you with their particular delusion so that you begin to not only question your own logic, but the rules of all known social engagement.

People who are capable of this “talent” tend to be a) grossly incompetent and acting defensively to protect the shrine of inadequacy they have spent a lifetime building, b) smart and manipulative, or c) both. Meeting someone who is both incredibly smart and grossly incompetent is indeed rare – it’s a bit like seeing a unicorn, except from what I have heard that tends to be a lovely experience of which many first graders enjoy drawing pictures.

Unfortunately, I spent the majority of my life dealing with mi loca tu loca from my family, although for the first 15 or 20 years I didn’t really understand what I was up against. Regardless, you would think that would make me somewhat of an expert on how to deal with it. Sadly, I don’t think it does, mainly because the laws of human interaction don’t apply to these soul-suckers, so often there is no rational way out. The only benefit I can see at this point is that I am a master MLTL detector. I am a f**cking bloodhound when it comes to identifying these folks. The feeling is always the same – a few minutes into a conversation, I get the distinct feeling that I am the unwitting victim of a Vulcan mind meld, and that a complete stranger is somehow brainwashing me into thinking that, even thought pure logic and reality would dictate otherwise, that somehow I am in the wrong or owe them something.

Normally, I can deal with these people on an occasional basis. But somehow, today was the perfect storm of folks who kept assaulting me with their voodoo magic in the hopes that I would suddenly agree that the sky is green and has three suns.

It started with a computer training that I had to complete for my new job. Mandatory, of course. Knowing how much I just love CBL experiences, I dutifully cancelled half a day of work to schedule a three hour training session. And as a freelancer, that cost me. People with full time jobs don’t always realize that taking off work for us consultant folks hits us right in the wallet. But I didn’t mind – it’s just one of those things you do and get on with your life.

Turns out that I was the only one scheduled for this training, which meant I had the full attention of the instructor for three hours. Initially I thought this wouldn’t be such a bad thing, as I could monopolize her with my individual questions and not feel guilty for hijacking a class.

As the session went on, however, I quickly realized two things. The first was that this woman was truly from a computer based learning cult, and she had drunk the Koolaid. I’m not sure how many times she waxed ecstatically over the program’s “exciting features” and “thrilling application potential”, but 30 minutes into it I was already exhausted, and she might as well have had pom poms and been wearing a cheerleader outfit.

The second, and more important, was that she clearly had an agenda for the afternoon that didn’t involve me. I had been scheduled from 1pm-4pm, and she informed me after we were an hour into the training that there was some sort of departmental meeting that was happening that day at 3pm.

That’s when the Vulcan mind meld started creeping in. Her tone changed ever so subtly as she told me that it was very possible that we would finish in 2 hours (fat chance), and that if we did, she could attend the meeting, but that she certainly didn’t want to shortchange my time. And she would be more than happy to schedule another session with me at a more convenient location for me so we could complete the training and give it the full attention it deserved. And that way everyone could get all the information they needed.

My thought process, already blunted by the assault of computer program information that had no real meaning for me yet, reflexively shifted over and I started mentally thumbing through my calendar, wondering if I could find a chink in my schedule to meet her at a local Starbucks for an hour. mindmeldmindmeldmindmeld

Luckily, all those years of family training kicked in, and I startled back into reality. Sorry, didn’t I already take off half a day of work to meet your training schedule, and now you are asking me to kick off an hour early and take off more work to reschedule with you so you can make some dumb meeting? And implying that I would be selfish not to?

Hell no lady. I politely but firmly informed her that this was the only day off this week that I was able to schedule this session (which was true), and that rescheduling for one hour of training simply wouldn’t be possible. She said of course she understood, but her expression completely conveyed the opposite. And she couldn’t resist one last dig (mindmeldmindmeldmindmeld) when she said she was pretty sure she could get the critical information she was missing from a colleague.

Once I had completed ALL THREE hours of training (with her becoming increasingly flustered after all that song and dance at actually being time pressured to finish), I was happy to get home and relax. Yet almost immediately, I got sucked into a ridiculously lengthy email exchange with an agency that had hired me for some consult work, accepted my terms of service, and then negged on paying my full invoice, claiming that reimbursement for travel and overtime had not been preapproved. The pinnacle of this asshattery was an email from the SENIOR accounting manager, who actually said, “I don’t know you at all….but c’mon….we’re all Human.” I mean, who talks like that? As if I am somehow going to suddenly bolt upright (mindmeldmindmeldmindmeld) and say, “By golly, you’re right! Who cares if you bilk me and all your other contractors out of money we are owed and propagate ethical fraud on the professional community at large? I mean, c’mon! I must have been crazy to complain to you!”